Ankle Brace Research Articles

Epidemiology of Lateral Ankle Ligament Injury: Trends in Clinical Management and Likelihood of Progression to Surgical Intervention

Category:AnkleIntroduction/Purpose:Lateral ankle ligament sprains occur frequently in both general and athletic populations. Most patients recover from their injury without complication, however, some experience persistent pain and instability following lateral ankle injury, which requires treatment with surgical stabilization. The purpose of this study is to determine the utilization and associated costs of non-operative treatment modalities, such as physical therapy (PT), non-steroidal anti-inflammatory medication, and ankle bracing, as well the incidence of lateral ankle sprains that receive surgical treatment and the costs incurred by surgical treatment of chronic lateral ankle instability.Methods:Data was collected using the Pearl Diver Humana dataset using ICD-9, ICD-10, and CPT codes pertaining to ankle sprain, ankle ligament repair or reconstruction, physical therapy, ankle brace ordering, and non-steroidal anti-inflammatory medication (NSAID) ordering. Patients diagnosed with an ankle sprain were sub-divided into three categories: non-operative treatment, surgical ligament repair, and surgical ligament reconstruction. Incidence, cost, and PT usage was compared between patient groups. Cost analysis was performed per group using associated ICD/CPT cost and physical therapy cost. NSAID use and ankle bracing use was also examined.Results:Of patients who sustained lateral ankle injury, 64% were female and 36% were male. 306,180 (98.8%) patients successfully completed non-operative management. 2,774 (1.2%) patients underwent surgical intervention. 63,276 (20.7%) non- operative patients received physical therapy, whereas 1,536 (55.4%) surgically treated patients received PT after surgery. Only 725 (26.1%) surgical patients received pre-operative PT. Median time for total PT treatment of surgical patients was 21.8 weeks, while non-operative patients received treatment for a median time of 58.7 weeks. On average non-operative patients generated 11 billed days in PT while surgical patients received 8 days of PT before surgery and 11 days in PT after surgery. Average total cost per patient was $923.32 for non-operative patients, $3,384.63 for surgical ligament repair, and $3,659.98 for surgical ligament reconstruction.Conclusion:The vast majority of patients with lateral ankle ligament sprains do not progress to surgical treatment. Patients treated non-operatively used fewer physical therapy visits per patient and generated less cost compared to surgically treated patients. Only 20% of non-operative patients received physical therapy. Additionally, a higher proportion of surgically treated patients participated in PT compared to patients treated non-operatively.

POSTERIOR TIBIAL TENDON INJURY - IS MISSED DIAGNOSIS, A POSSIBILITY? SHOULD IT BE SUSPECTED IN ALLANKLE EVERSION SPRAINS? - A CASE REPORT

Ankle sprains are one of the most common injuries that occur among people of all ages and accounts for 75% of ankle injuries and for 10 to 30 percent of sports-related injuries in young athletes. Inversion sprain is more common than eversion ankle sprain, to result in injury to the lateral ligament complex. Though injury to the posterior tibial tendon is not a very common injury associated with eversion ankle sprain, it often can be overlooked and missed in the initial physical examination. We present a case of a college student who sustained a twisting injury to his left ankle while playing football. After initial history, physical examination and plain radiographic evaluation, a diagnosis of eversion ankle sprain was made by a general practitioner and treated conservatively. Due to persistent symptoms and local signs, subsequent evaluation with an MRI study revealed tibialis posterior (TP) tendon strain with diffuse soft tissue swelling extending up to lower third of the leg and associated Grade I osteochondral injury to the posterolateral aspect of talus. The injury was successfully treated with medial arch support ankle brace, analgesics, guarded weight bearing and physiotherapy with full functional recovery in 12 weeks.

The Effect of Ankle Brace Use on a 3-Step Volleyball Spike Jump Height

PurposeThe purpose of this study was to determine whether ankle brace use in university-level varsity volleyball athletes affected their 3-step spike jump height and whether certain types of ankle braces have a greater effect on jump height.MethodsNine male university-level varsity volleyball athletes participated in a repeated-measures design study in which each athlete performed three 3-step volleyball spike jumps in 3 ankle brace conditions (soft, rigid, and no brace). Vertical jump height was measured by the Vertec device and video motion analysis at a university biomechanics research laboratory.ResultsVertical jump heights were significantly lower in both brace conditions (soft, 2.3 cm, standard deviation [SD] 1.2 cm, P < .001; rigid, 1.7 cm, SD 0.9 cm, P < .003) compared with the no-brace condition, and no differences in vertical jump height were observed between the brace conditions (0.6 cm, SD 0.3, P = .3). There was a negative correlation between body fat percentage and vertical jump height (r = –0.075, P = .02). The Vertec device reliably measured vertical jump in all 3 conditions. The no-brace vertical ground reaction forces during the loading phase were significantly greater than brace conditions. Ankle range of motion was greatest in the no-brace condition.ConclusionsResults from this study suggests that high-performance athletes wearing ankle braces experience a significant decrease in vertical jump height independent of the type of ankle brace worn.Clinical RelevanceSports physicians and health care providers caring for high-level athletes should counsel athletes on the trade-offs of wearing protective equipment in sport, as potential decreases in sports performance can lead to increased injury prevention.Level of EvidenceIII.

Ankle bracing’s effects during a modified agility task: analysis of sEMG, impulse, and time to complete using a crossover, repeated measures design

ABSTRACT This study explored the effects of no braces, softshell (AE), and semi-rigid (T1) ankle braces on time to complete a modified agility task, as well as lower extremity muscle activity and impulse during the change of direction component of the task. Thirty-nine healthy, active individuals completed a modified agility task under the three brace conditions. Time to complete the modified agility task, along with mean surface electromyographic activity (sEMG) and impulse during the deceleration and propulsive phases of the task were measured. There were no significant differences across conditions with respect to sEMG or impulse measures during the deceleration or propulsive phases. There was a significant change in time to complete the modified agility task, F(2,76) = 17.242, p< 0.001, ηp2 = 0.312. Post-hoc analysis revealed a significant increase in time to complete the modified agility task when wearing the AE (0.16 (95% CI, 0.062 to 0.265) seconds, p< 0.001) and T1 (0.20 (95% CI, 0.113 to 0.286) seconds, p< 0.001) ankle braces compared to no braces. It appears that performance on a modified agility task may be diminished when wearing ankle braces, although sEMG activity and impulse are unaffected.

Left Foot Injury In A Female Gymnast

HISTORY: A 17-year-old female high level gymnast presented for evaluation of left heel pain and ecchymosis. Two days prior to her presentation, she was sprinting in preparation for a roundoff prior to vault take-off and felt her heel shift when she went to push-off. She fell and was immediately unable to bear weight secondary to heel pain. Pain was exacerbated by any weight-bearing activity and improved with rest. She had been wearing a walking boot and using crutches for ambulation. PHYSICAL EXAMINATION: Healthy-appearing female with a muscular build in no apparent distress. Antalgic gait favoring left foot, avoiding pressure on heel. Ecchymosis along both the medial and lateral aspects of the calcaneus. Tenderness to palpation and associated swelling at the plantar aspect of the calcaneus and along the subtalar joint. Ankle range of motion was full and pain-free. Pain with resisted eversion. Talar tilt and calcaneal squeeze tests were positive. No pain with plantar fascia stretching or palpation along the mid to distal plantar fascia. Achilles tendon was intact. Anterior drawer was negative. Strength was full and light touch sensation was intact. DIFFERENTIAL DIAGNOSIS: 1. Calcaneal stress fracture 2. Subtalar joint subluxation 3. Plantar fascia tear TEST AND RESULTS: Left ankle and foot radiographs were negative for acute fracture or dislocation. Left ankle MRI revealed a focal tear involving the lateral margin of the lateral cord of the plantar aponeurosis. FINAL WORKING DIAGNOSIS: Lateral cord plantar fascia rupture TREATMENT AND OUTCOMES: 1. Walking boot for 6 weeks with gradual wean out of boot during the 6th week and ankle range of motion exercises when out of the boot. 2. Once out of boot, supportive shoes with ankle brace and dorsiflexion night splint at night. 3. Physical therapy focusing on Achilles stretching, ankle range of motion and strengthening until pain and tenderness resolved. Slowly advanced to more sports-specific tasks once pain-free. 4. At 10 weeks post injury, she was pain free while performing plyometric and balance/proprioceptive exercises and had a normal exam with full pain-free range of motion. 5. Functional return to sport given her normal exam and pain-free activity with physical therapy.

The effect of silicone ankle sleeves and lace-up ankle braces on neuromuscular control, joint torque, and cutting agility

ObjectiveTo evaluate the effects of silicone ankle sleeves (SASs) and lace-up ankle braces (LABs) on neuromuscular control, net joint torques, and cutting agility in healthy, active individuals. DesignMarkerless motion-capture technology tracked subjects fitted with SASs, LABs, or no brace while they performed the movements: Y-excursion, left cutting, right cutting, single-leg drop vertical jump (SLDVJ), 45-degree bound, and single-leg squat (SLS). SettingUniversity Laboratory. ParticipantsTen healthy, active individuals (5 males and 5 females, mean ± SD 23.60 ± 1.43 years of age). Main outcome measuresDegrees of joint range of motion (ROM), Newton-meters of joint torque, time to perform a cutting maneuver. ResultsSASs and LABs resulted in significantly different knee and ankle ROM and hip internal rotation in the SLDVJ, SLS, Y-excursion, cutting maneuver, and 45-degree bound when compared to control (p < .05). Both ankle and knee torque were significantly reduced in the 45-degree bound and cutting movements with both types of PABs (p < .05). There were minimal differences between the SASs and LABs for all conditions. There were no statistically significant differences in cutting times for any of the 3 conditions. ConclusionBoth SAS and LAB positively impacted neuromuscular control, reduced net joint torque, and neither impaired cutting agility when compared to control.

The effect of three different ankle braces on local dynamical stability of individuals with chronic ankle instability during Running

The purpose of this study was to determine the effect of three different ankle braces using the Maximum Lyapunov exponent on local dynamical stability of individuals with chronic ankle instability during running. Twelve subjects with chronic ankle instability as injured group and 12 healthy individuals participated in this study. Injured group performed 70 strides of treadmill running in shoe and rigid, semi-rigid and soft braces as well as no-brace conditions. The healthy group performed the test only in no-brace condition. Kinematics data were used to calculate the short time (λ_S) and long time (λ_L) maximum Lyapunov exponent. The results showed that λ_S of running in semi-rigid brace is significantly different with running in other braces in chronic ankle instability group; but it was not different with the control group. It seems running in semi-rigid brace in chronic ankle instability group provides stability like healthy control group.

Effects of Different Ankle Supports on the Single-Leg Lateral Drop Landing Following Muscle Fatigue in Athletes with Functional Ankle Instability

Background: Ankle support has been utilized for athletes with functional ankle instability (FAI), however, its effect on the landing performance during muscle fatigue is not well understood. This study aimed to examine the effects of ankle supports (ankle brace vs. Kinesio tape) on athletes with FAI following fatigued single-leg landing. Methods: Thirty-three young FAI athletes (CAIT scores < 24) were randomly allocated to control (Cn), ankle brace (AB) and Kinesio tape (KT) groups. All athletes performed single-leg lateral drop landings following ankle fatigue protocol. The fatigue-induced changes in kinetic parameters were measured among three groups. Results: A significant increase in peak vertical ground reaction force (vGRF) was found in the AB group (0.12% body weight (BW)) compared to that of the KT (0.02% BW) and Cn (median = 0.01% BW) groups. Significant decrease in both COP medial-lateral (ML) and anterior-posterior (AP) ranges were also found in the KT group (median = −0.15% foot width (FW) & median = −0.28% foot length (FL)) than those of the Cn group (median = 0.67% FW& median = 0.88% FL). Conclusions: Ankle braces might hamper the ability to absorb the impact force during landing. On the other hand, Kinesio tape might be beneficial for the postural control during landing.

ANKLE BRACE USE AND RISK OF ACUTE LOWER EXTREMITY INJURY AMONG FEMALE HIGH SCHOOL VOLLEYBALL PLAYERS

Background:Lower extremity injuries (LEIs), particularly ankle sprains, are the most common injury reported among female volleyball players. Many athletes wear ankle braces to help prevent injury; however, it is unknown whether ankle brace use reduces the rate and severity of ankle and LEI in these athletes.Hypothesis/Purpose:Determine if ankle brace use is associated with a reduced rate and severity of LEIs and ankle injuries among female high school volleyball players.Methods:2073 female volleyball players from 78 high schools were prospectively followed for injury, including acute LEI, during their fall 2018 volleyball season. Baseline data was collected on each participant including ankle brace use and type worn. Brace type was classified as soft- (e.g. fabric) or hard-shell. Injury severity was measured as days lost from sport. Incidence rates are reported per 1000 athlete exposures.Results:210 acute LEIs were observed during the season, of which 122 (58%) were ankle injuries. 76% of non-contact LEIs were due to jumping/landing or rotating around a planted foot. Similarly, 76% of contact LEIs were due to the floor or a teammate. The rate of LEI for athletes wearing soft-shell(SS) braces was 1.14 (95% CI: 0.76, 1.72), compared to 0.53 (95% CI: 0.25, 1.10) for those wearing hard-shells (HS) and 0.52 (95% CI: 0.37, 0.71) for those not wearing braces (NONE). The rate of a LEI for athletes wearing SS was 2.22 (95% CI: 1.31, 3.74) times as high as that for NONE (p=0.003). No association was found between LEI risk in athletes wearing HS versus NONE (IRR: 1.02, 95% CI: 0.45, 2.30). Similarly, the rates of ankle injury for HS, SS and NONE were 0.08 (95% CI: 0.01, 0.530), 0.40 (95% CI: 0.20, 0.79), and 0.16 (95% CI: 0.09, 0.28), respectively. The rate of ankle injury was 2.5 times as great in participants wearing SS compared to NONE (p=0.04). No association was detected for HS braces (p=0.48). No difference in median days lost for LEI (HS: 2[IQR 1,13], SS: 4[1, 10] None: 3[1,9]) or ankle injury (HS: 7[IQR 2,13], SS: 5[1, 11] None: 3[1,10]) was detected by brace use (p=0.99, p=0.79, respectively).Conclusion:The use of SS braces resulted in an increased risk of LEI and ankle injury among female high-school volleyball players; moreover, HS braces were not found to be associated with injury risk nor did ankle brace use affect severity of LEI and ankle injury in this population.

Effect of Sex and Ankle Brace Design on Knee Biomechanics During a Single-Leg Cut

Background: Despite success at preventing ankle sprain, prophylactics that restrict ankle plantarflexion motion may produce deleterious knee biomechanics and increase injury risk. Purpose: To determine if ankle prophylactics that restrict plantar- and dorsiflexion motion produce changes in knee biomechanics during a single-leg cut and whether those changes differ between sexes. Study Design: Controlled laboratory study. Methods: A total of 17 male and 17 female participants performed a single-leg cut with 4 conditions: Ankle Roll Guard (ARG), lace-up brace, nonelastic tape, and an unbraced control. Peak stance knee flexion, abduction, and internal rotation joint angle and moment; total knee reaction moment (TKM) and its components (sagittal, frontal, and transverse); and ankle plantarflexion and inversion range of motion (ROM) and peak stance joint moments were tested with a repeated measures analysis of variance to determine the main effect and interaction of condition and sex. Results: Brace and tape restricted plantarflexion ROM as compared with ARG and control (all P < .001). With the brace, women had increased peak knee abduction angle versus ARG (P = .012) and control (P = .009), and men had decreased peak knee internal rotation moment as compared with ARG (P = .032), control (P = .006), and tape (P = .003). Although the restrictive tape decreased inversion ROM when compared with ARG (P = .004) and brace (P = .017), it did not change knee biomechanics. Neither brace nor tape produced significant changes in TKM or components, yet sagittal TKM increased with ARG versus control (P = .016). Women exhibited less ankle inversion ROM (P = .003) and moment (P = .049) than men, while men exhibited significantly greater frontal TKM (P = .022) and knee internal rotation moment with the ARG (P = .029), control (P = .007), and tape (P = .016). Conclusion: Prophylactics that restrict ankle plantarflexion motion may elicit knee biomechanical changes during a single-leg cut, but these changes may depend on prophylactic design and user’s sex and may increase women’s injury risk. Clinical Relevance: Sex-specific ankle prophylactic designs may be warranted to reduce knee injury during sports.

Ankle Bracing Alters Coordination and Coordination Variability in Individuals With and Without Chronic Ankle Instability.

Ankle bracing is an effective form of injury prophylaxis implemented for individuals with and without chronic ankle instability, yet mechanisms surrounding bracing efficacy remain in question. Ankle bracing has been shown to invoke biomechanical and neuromotor alterations that could influence lower-extremity coordination strategies during locomotion and contribute to bracing efficacy. The purpose of this study was to investigate the effects of ankle bracing on lower-extremity coordination and coordination dynamics during walking in healthy individuals, ankle sprain copers, and individuals with chronic ankle instability. Mixed factorial design. Laboratory setting. Forty-eight recreationally active individuals (16 per group) participated in this cross-sectional study. Participants completed 15 trials of over ground walking with and without an ankle brace. Coordination and coordination variability of the foot-shank, shank-thigh, and foot-thigh were assessed during stance and swing phases of the gait cycle through analysis of segment relative phase and relative phase deviation, respectively. Bracing elicited more synchronous, or locked, motion of the sagittal plane foot-shank coupling throughout swing phase and early stance phase, and more asynchronous motion of remaining foot-shank and foot-thigh couplings during early swing phase. Bracing also diminished coordination variability of foot-shank, foot-thigh, and shank-thigh couplings during swing phase of the gait cycle, indicating greater pattern stability. No group differences were observed. Greater stability of lower-extremity coordination patterns as well as spatiotemporal locking of the foot-shank coupling during terminal swing may work to guard against malalignment at foot contact and contribute to the efficacy of ankle bracing. Ankle bracing may also act antagonistically to interventions fostering functional variability.

Biomechanical Analysis of Midfoot Instability After Bifurcate Ligament Injury and Ankle Brace Application: A Cadaveric Study

This cadaveric study investigated the biomechanical characteristics and stabilizing contribution of the bifurcate ligament using a multidirectional loading method and assessed the stabilizing effect of a brace after injury of the ligament. Eight freshly frozen cadaveric feet were tested for forefoot torque in inversion, eversion, adduction, and plantarflexion. Each band of the bifurcate ligament was transected sequentially, and the contribution of each portion of the ligament, as well as the stabilizing effects of the ankle brace, were examined. Stability decreased substantially after calcaneocuboid ligament transection for inversion and adduction loading. Bracing restored some stability, except for the adduction loading direction, for which it had only limited effect. The data indicate that inversion and adduction loading are strongly related to bifurcate ligament injury. The stabilizing effect of the ankle brace may have limited effectiveness for loads under adduction.

Research and Application of Ankle Morphological Changes and Classification

Because of the motion of ankle joint, the surface morphological changes. The relevant products including ankle brace, ankle boot, etc. with both important protective effect on ankle and comfort should be designed to match the ankle varies states. The samples data with 15° plantar flexion, 40° dorsiflexion and neutral position of lower limbs(N=105) were scanned. This study analyzed the feature of the ankle morphological changes and divided it into four parts: anterolateral (I), posterolateral (II), posteromedial (III) and anteromedial (IV). The anterior and posterior parts had large contraction and expansion during plantar flexion and dorsiflexion motions. The medial and lateral parts of ankle shape were asymmetric, but had equal skin areas. Therefore, the area of the entire ankle surface remained almost the same when morphological changes. We unified the data of the models and measured the distances of characteristic points. According to the main dimensions, the ankles were classified into 17 groups. The rigid brace design was taken as an example to fit mass ankles. It showed a great statistical comfort degree in total by the user experience and evaluation. The method combining with features of ankle morphological changes and shape classification was proved to be effective for the ankle related products design to fit mass ankles.

The effects of ankle barcing to the volleyball players performance

Volleyball is characterized by short and quick movements. The repetitive jumping and side-to-side movements required in volleyball increase the risk of injuries to the foot and ankle. Ankle injuries, particularly sprains, are the most common injuries sustained in volleyball. Ankle bracing used extensively to enhance ankle joint stability, prevent injury occurrence, and mitigate severity. Ankle braces are not mandatory in volleyball but it commonly used during the rehabilitation period after ankle sprains by the players for a long time. There are some adverse effects of bracing. Pressure to the muscles surrounding the joint can result additional damage such as muscle weakness. Muscle weakness can impair athletic performance can decrease jumping height. We measured and compared vertical jump height on braced and unbraced conditions. The results showed that, the tallest jump, less time for jumping and maximal force impulse were accounted for the unbraced condition.

Osteoarthritis of the ankle

Ankle arthritis is a debilitating condition. Primary ankle joint osteoarthritis is much rarer than hip or knee arthritis. The majority of cases are post-traumatic secondary to previous articular trauma or ligamentous instability. Treatment methods available are guided by disease severity and the patient's functional demands. Weight loss, activity modification, the wearing of an ankle brace or high-topped lace-up boots and orthoses should be the first line of treatment. Joint-sparing procedures such as arthroscopic debridement, supramalleolar osteotomy and distraction arthroplasty have been trialled with low levels of supporting evidence. The demand for joint preservation has led to the development of total ankle allografting procedures, but these have fallen out of favour. Despite advancements, the gold standard for end-stage arthritis remains arthrodesis, although evidence for total ankle arthroplasty in certain groups of patients is increasing. The current third-generation implants have improved survivorship although their results remain inferior to arthroplasty of the hip and knee. There is currently a UK randomized control trial of ankle replacement versus arthrodesis under way as well as several national joint registries, which will hopefully better define those patients who will gain most benefit from replacement as opposed to fusion.

Gait Biomechanics Following Taping and Bracing in Patients With Chronic Ankle Instability: A Critically Appraised Topic.

Clinical Scenario: Approximately 30% of all first-time patients with LAS develop chronic ankle instability (CAI). CAI-associated impairments are thought to contribute to aberrant gait biomechanics, which increase the risk of subsequent ankle sprains and the development of posttraumatic osteoarthritis. Alternative modalities should be considered to improve gait biomechanics as impairment-based rehabilitation does not impact gait. Taping and bracing have been shown to reduce the risk of recurrent ankle sprains; however, their effects on CAI-associated gait biomechanics remain unknown. Clinical Question: Do ankle taping and bracing modify gait biomechanics in those with CAI? Summary of Key Findings: Three case-control studies assessed taping and bracing applications including kinesiotape, athletic tape, a flexible brace, and a semirigid brace. Kinesiotape decreased excessive inversion in early stance, whereas athletic taping decreased excessive inversion and plantar flexion in the swing phase and limited tibial external rotation in terminal stance. The flexible and semirigid brace increased dorsiflexion range of motion, and the semirigid brace limited plantar flexion range of motion at toe-off. Clinical Bottom Line: Taping and bracing acutely alter gait biomechanics in those with CAI. Strength of Recommendation: There is limited quality evidence (grade B) that taping and bracing can immediately alter gait biomechanics in patients with CAI.

Ankle bracing practices in ambulatory, corticosteroid‐naive boys with Duchenne muscular dystrophy

Loss of ambulation in Duchenne muscular dystrophy presages scoliosis, respiratory failure, and death. Strategies to maintain ankle range of motion are employed, but little evidence exists to support these approaches and limited information is available concerning current practice. In this study we assessed baseline bracing data from 187 boys participating in a multicenter, international clinical trial. Ankle-foot orthoses (AFOs) were recommended for 54% of the boys, with nighttime static AFOs and nighttime dynamic AFOs utilized in 94% and 6% of these boys, respectively. Daytime static AFOs were recommended for 3 boys. Compliance with bracing recommendations was 54% for nighttime static braces and 67% for nighttime dynamic braces. The basis for the variation in recommended AFO use is unknown and requires further study. Long-term follow-up of boys may permit assessment of the effects of AFO use.

Do External Supports Improve Dynamic Balance in Patients with Chronic Ankle Instability? A Network Meta-analysis.

To improve ankle stability in patients who have experienced an ankle sprain with residual symptoms of instability and/or objective joint laxity, external supports (such as taping, bracing, and orthotic insoles) are used sometimes. However, available randomized trials have disagreed on whether restraints improve balance in those individuals. In this situation, a network meta-analysis can help because it allows for comparing multiple treatments simultaneously, taking advantage not only of direct but also indirect evidence synthesis. The aim of this network meta-analysis was to assess (1) the impact of taping and orthotic devices on dynamic postural control in individuals with ankle instability and (2) the presence of a placebo effect in participants treated with sham taping and complications resulting from the administered treatments. We searched the PubMed, Scopus, and CENTRAL databases up to February 13, 2019 for completed studies. Randomized trials assessing the results of real and/or sham taping, wait-and-see protocols, ankle bracing, and foot orthotics for ankle instability as determined by one or more ankle sprains followed by ongoing subjective symptoms and/or mechanical laxity were included. We evaluated dynamic postural control in terms of the Star Excursion Balance Test in the posteromedial direction (SEBT-PM), which is considered the most representative of balance deficits in patients with ankle instability. Standardized mean differences were re-expressed to percentage differences in SEBT-PM, with higher scores representing possible improvement. Subsequently, those data were checked against the established minimal detectable change of 14% for this scale to make judgements on clinical importance. We also assessed the presence of a placebo effect by comparing the results of sham taping with no treatment and complications resulting from the administered treatments. Additionally, we judged the quality of trials using the Cochrane risk of bias tool and quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. A total of 22 trials met our inclusion criteria, 18 of which were deemed to be at a low risk of bias. A network of treatments consisting of 13 studies was created, and the level of evidence was judged to be high. As far as participants' allocation to treatment arms, 85 patients followed a wait-and-see protocol, 29 received placebo taping, 99 were treated with taping, 16 were treated with bracing, 27 were administered insoles, and six individuals were offered a combination of insoles with bracing. Of note, with statistical power set at 80%, a minimum of 16 patients per treatment group was required to provide sufficient statistical power and detect a SEBT-PM percentage difference of 14%. A network meta-analysis did not demonstrate a benefit of taping or bracing over no treatment (percentage difference in SEBT-PM between taping and bracing versus control: -2.4 [95% CI -6 to 1.1]; p = 0.18, and -7.5 [95% CI -15.9 to 1]; p = 0.08, respectively). This was also the case for sham taping because the measurement increase failed to exceed the minimal detectable change (percentage difference in SEBT-PM between sham taping and untreated control: -1.1 [95% CI -6.9 to 4.7]; p = 0.72). Importantly, there were no reported adverse events after treatment application. Evidence of moderate strength indicated that external supports of any type were no more effective than controls in improving dynamic postural control in patients with at least one ankle sprain and residual functional or mechanical deficits. Therefore, implementing those tools as a standalone treatment does not appear to be a viable strategy for the primary management of ankle instability. It is conceivable that combinations of rehabilitation and external supports could be more effective than external supports alone, and future trials should evaluate the potential of such combinations in enhancing not only clinician-reported but also patient-oriented outcomes using long-term follow-up measurements. Level I, therapeutic study.

Late Abduction Deformity of the Midfoot Following the “Medial Double” (Diple) Procedure for Hindfoot Valgus Deformity

Category:HindfootIntroduction/Purpose:There has been considerable interest in recent years in performing a combined talonavicular and subtalar arthrodesis instead of a standard triple arthrodesis for a rigid hindfoot deformity. The ”medial double” (diple) avoids fusing the calcaneocuboid joint with its lateral incision, common bone block graft and high rate of complications. Although the results of the “medial double” are generally satisfactory, there are no reports of late midfoot abduction deformity, although it was predicted by Evans in 1975.Methods:A 79 year-old-male with long-standing skin psoriasis with joint involvement presented with severe bilateral flatfoot deformities. The left hindfoot was arthritic, deformed and painful. Despite a conservative course of orthotics and ankle braces, the pain persisted. Because there was a psoriatic plaque over the lateral side of the foot, it was decided to perform a ”medial double” arthrodesis with screw fixation, a plantarflexing 1st tarsometatarsal joint fusion for medial column stabilization, and a heel cord lengtheningResults:Skin and bony healing were uneventful. Over the subsequent three years a progressive abduction deformity developed through the naviculocuneiform joints and the unfused calcaneocuboid joint. The patient had only occasional pain in the midfoot and wore wide shoewear to accommodate the deformity.Conclusion:A late abduction deformity can develop through the midfoot in patients who have the ‘medial double” procedure for hindfoot valgus. The cuboid settles proximally against the short distal calcaneus, and the naviculocuneiform joints sublux laterally. In patients with hindfoot valgus with severe lateral column shortening secondary to calcaneocuboid joint remodeling, it may be better to perform an actual triple arthrodesis with a bone graft in the calcaneocuboid joint instead of a “medial double.” Alternatively, one could add a naviculocuneiform arthrodesis to the ”medial double” arthrodesis to prevent this complication.

Effect of soft and semi-rigid ankle braces on kinematic and kinetic changes of the knee and ankle joints after forward and lateral drop landing in healthy young women

Effect of soft and semi-rigid ankle braces on kinematic and kinetic changes of the knee and ankle joints after forward and lateral drop landing in healthy young women