Ankle Exercise Research Articles

A Wearable Multi Direction Ankle Exercise Device for DVT Prevention Using Thin McKibben Muscles

A Wearable Multi Direction Ankle Exercise Device for DVT Prevention Using Thin McKibben Muscles

Effect of Ankle Resisted Exercises on Venous Leg Ulcers Healing

AbstractBackground: Venous leg ulcers are open chronic wounds that occur within the gaiter region of the leg (from below the ankle, up to mid-calf) and are a consequence of venous insuffciency. They typically present as repeated cycles of ulceration, healing, and recurrence. Such ulcers can take weeks or months to heal, and 12-month recurrence rates are between 18% and 28%. They are painful, malodorous, prone to infection, and severely affect patients' mobility and quality of life, therefore resisted ankle exercises is improving calf muscle pump action by increasing ankle (plantar flexion) range of motion which improving venous system function in the lower leg and so improving 2nd and 3rd degrees of venous leg ulcers healing.Aim of Study: The aim of this was to determine the efficacy of resisted ankle exercises on healing of venous leg ulcers.Subjects and Method: Thirty patients suffering from 2nd and 3rd chronic venous leg ulcers were recruited from Vascular Surgical Outpatient Clinic of Al-Hussien University Hospital. Their ages ranged from 45 to 60 years old: They distributed into two Groups (A & B). Group (A) study group: Fifteen patients who received ankle resistance training exercise in addition to the traditional medical treatment. Group (B) control group: Fifteen patients who received only the tradi-tional medical treatment. Resistance training exercise was applied in the form 20 or 25 repetitions maximum at the end of the twelve week, three sessions per week, every other day, for three months.Results: Results showed that ankle resistance training exercise program was effective in improving healing of venous leg ulcers by decreasing ulcers' volume measured by sterilized saline solution by improving calf muscle pump function.Conclusion: Application of 12 weeks ankle resisted exer-cises in patient with 2nd and 3rd degrees of chronic venous leg ulcers resulted in decreasing volume of venous ulcers and so increasing of healing rates.

The Footfall Programme: participant experiences of a lower limb, foot and ankle exercise intervention for falls prevention - an exploratory study.

Objectives:Despite growing evidence that foot and ankle exercise programmes are effective for falls prevention, little is known about older adults’ views and preferences of programme components for long-term maintenance. The aims of this study were to explore the experiences and acceptability of Scottish and Portuguese older adults of undertaking a home-based foot, ankle and lower limb exercise intervention.Methods:Ten Scottish (mean age 76 years, 7 female) and fourteen Portuguese (mean age 66 years, 12 female) community-dwelling older adults undertook the programme for one week, followed by focus group discussions (2-6 people per group), guided by a semi-structured interview guide. Data was analysed using thematic analysis.Results:Seven themes were identified:Assessment, Group exercise taster, Home based exercise; Footfall programme kit, Midweek phone call, Reasons for participation and the Research Process. Programme components, support telephone calls and research procedures were generally well accepted by participants and they valued having a contribution to the design. They preferred a blended home and intermittent group-based programme format for motivation and progression and recommended changes to some of the exercises and equipment to reduce barriers to participation. Some cultural differences emerged, including importance of the functional assessments for Portuguese participants, time issues and difficulty in completion of the exercise diary, reflecting lower literacy levels.Conclusions:Participants found the programme acceptable but preferred a blended home and occasional group-based programme for adherence and motivation. A strong educational component to improve health literacy and simple paperwork completion to avoid data loss in future studies with Portuguese older adults is important.

Rehabilitation technology for self-care: Customised foot and ankle exercise software for people with diabetes.

AimsTo develop and validate the content of a free web-based software (desktop and mobile applications) for the self-management of and customised foot-ankle exercises for people with diabetes and diabetic neuropathy.MethodsThe development of the programme was based on gamification principles and addressed three main areas: foot care recommendations; self-assessment of feet according to the main complications of diabetic neuropathy; and customised foot-ankle exercises to strengthen muscles, increase the range of motion and improve functionality. The content was validated using the Delphi methodology and a quantitative approach in two rounds with diabetes specialists (n = 9) and users with diabetes (n = 20). A 70% approval rate was considered sufficient in the second round for final validation purposes. The data analysis was conducted using descriptive statistics, absolute and relative frequencies and the content-validity index (CVI).ResultsAmong specialists, the CVI was 0.812 after the first round, and final approval was 100% after the second round. Among users, the CVI was 0.902 in the first round, and the final approval was 97%.ConclusionThis free access web software was developed based on the high agreement rating between specialists and users and has the potential to prevent complications arising from diabetic polyneuropathy. It allows for self-monitoring and promotes personalised exercises, following a preventive model that can be applied in primary and secondary care services as a complementary treatment for chronic complications. However, further steps to validate the software in a larger population are recommended.

AKTIVITAS FISIK PADA PASIEN DIABETES MELITUS TIPE 2 DENGAN NEUROPATI PERIFER : TINJAUAN LITERATUR

Type 2 diabetes mellitus is a chronic disease that could cause damage to foot peripheral nerves, namely peripheral neuropathy. Diabetic peripheral neuropathy is a damage and inability to regenerate nerve cells due to exposure of chronic hyperglycemia which can lead to various symptopms and complications. Therapy is aimed at improving symptoms and delaying development of peripheral neuropathy, one of which is physical activity which is one of the cornerstones of management of diabetes mellitus. An explanation of the benefits of physical activity in diabetes mellitus has been widely discussed, but nore in peripheral neuropathy. This literature review aims to explain the types and benefits of physical activity in peripheral neuropathy. Seven literature reviewed were obtained through electronic database search EBSCOHost, Proquest, and Clinical Key with key words physical activity, exercise intervention, diabetic peripheral neuropathy, and type 2 diabetes mellitus. Peripheral neuropathy patients can carry out various types of physical activity, either weight bearing or non-weight bearing exercise. Patients with ulcers, wounds and severe foot deformity can do non-weight bearing exercise such as static cycling and upper body ergometer. Another can do walking, aerobics, balance exercises, stretching, tai chi, resistance training, and foot ankle exercises. Aerobics is a physical activity that can prevent and delay development of peripheral neuropathy. Balance training can improve sensory and motor neuropathy. In general, physical activity can improve innervation in the cutaneous tissue, regenerate nerve cells, improve the symptoms of neuropathy in the form of pain, balance disorders, risk of falls, and obstacles to physical mobility.

Developement of a Wearable Multi Direction Ankle Exercise Device for DVT Prevention

Developement of a Wearable Multi Direction Ankle Exercise Device for DVT Prevention

Femoral venous flow velocity during passive ankle exercise in patients with chronic spinal cord injury.

[Purpose] We examined the effect of passive ankle exercise on femoral venous flow in paralyzed, atrophied lower legs of patients with chronic spinal cord injury. [Participants and Methods] Ten males with complete spinal cord injury at the T6–12 levels and ten able-bodied males participated in this study. B-mode muscle ultrasound was performed on the medial gastrocnemius muscle to evaluate muscle atrophy. Doppler ultrasound was used to measure the time-averaged mean velocity in the femoral vein at rest and during passive motion of the ankle. [Results] Mean muscle thickness was significantly reduced in the spinal cord injury group, showing a mean value of 67.2% compared with able-bodied participants. No significant differences were observed in the time-averaged mean velocity at rest between the groups, although they were slightly lower in the spinal cord injury group than in the able-bodied group. During passive motion, no significant difference was observed in the time-averaged mean velocity between the groups, although the mean value in those with spinal cord injury was 65.9% that of the able-bodied group. Time-averaged mean velocity increased in both groups, compared with baseline. [Conclusion] Passive ankle exercise increased time-averaged mean velocity in spinal cord injury, but venous blood velocity was reduced in spinal cord injury compared to the able-bodied group. We believe that significant muscle atrophy affected our results in chronic spinal cord injury.

Effect of a Soft Robotic Sock Device on Lower Extremity Rehabilitation Following Stroke: A Preliminary Clinical Study With Focus on Deep Vein Thrombosis Prevention.

Background and objective: Immobility of the lower extremity due to medical conditions such as stroke can lead to medical complications such as deep vein thrombosis or ankle contracture, and thereafter prolonged recovery process of the patients. In this preliminary clinical study, we aimed to examine the effect of a novel soft robotic sock device, capable of providing assisted ankle exercise, in improving blood flow in the lower limb to prevent the complication of strokes such as deep vein thrombosis and joint contracture. Methods: Stroke patients were recruited (n = 17) to compare patients using the conventional pneumatic compression device with our robotic sock device on separate days. The primary outcome was to compare the venous flow profile of the superficial femoral vein in terms of the time average mean velocity and volumetric flow. The secondary outcome was to identify the ankle joint range of motion with the assistance of the device. Results: We noted improvements in the venous profile at the early phase of the device use, though its efficacy seemed to drop with time, as compared to the IPC device, where there was a significant improvement in the venous profile. The ankle joint dorsiflexion-plantarflexion range of motion assisted by the device was 11.5±6.3°. Conclusion and clinical impact: The current version of our sock device appears to be capable of improving venous blood flow in the early phase of device use and assisting with ankle joint exercise. The insights from this preliminary clinical study will serve as the basis for further improvement of the device and subsequent conduct of a longitudinal clinical trial. Funding: National Health Innovation Centre Singapore (NHIC) grant, R-172-000-391-511, MOE AcRF Tier 1 R-397-000-301-114.

Prescribed Exercise With Compression vs Compression Alone in Treating Patients With Venous Leg Ulcers

Exercise is recommended as an adjuvant treatment for venous leg ulceration (VLU) to improve calf muscle pump function. However, the association of exercise with VLU healing has not been properly aggregated, and the effectiveness of different exercise interventions has not been characterized. To summarize the association of different exercise interventions with VLU healing when used as an adjuvant to any form of compression. The Cochrane Controlled Trials Register, MEDLINE, Embase, CINAHL, PsycInfo, and SCOPUS databases were searched through October 9, 2017. Randomized clinical trials (RCTs) of any exercise compared with no exercise in participants with VLU were included, where compression was used as standard therapy and a healing outcome was reported. Independent title screening and full text review by 2 authors (A.J., J.S.) with appeal to a third author (J.P.) if disagreement was unresolved. Of the 519 articles screened, a total of 6 (1.2%) studies met the inclusion criteria for systematic review, including 5 for meta-analysis. Independent quality assessment for Cochrane risk of bias and data extraction by 2 authors with appeal to third author if disagreement unresolved (PRISMA). Data pooled using fixed effects model. The a priori primary outcome was any healing outcome (proportion healed, time to healing, or change in ulcer area). Secondary outcomes (adverse events, costs, and health-related quality of life) were only collected if a primary outcome was reported. Six RCTs were identified and 5 (190 participants) met inclusion criteria for meta-analysis. The exercise interventions were progressive resistance exercise alone (2 RCTs, 53 participants) or combined with prescribed physical activity (2 RCTs, 102 participants), walking only (1 RCT, 35 participants), or ankle exercises (1 RCT, 40 participants). Overall, exercise was associated with increased VLU healing at 12 weeks although the effect was imprecise (additional 14 cases healed per 100 patients; 95% CI, 1-27 cases per 100; P = .04). The combination of progressive resistance exercise plus prescribed physical activity appeared to be most effective, again with imprecision (additional 27 cases healed per 100 patients; 95% CI, 9-45 cases per 100; P = .004). The evidence base may now be sufficiently suggestive for clinicians to consider recommending simple progressive resistance and aerobic activity to suitable patients with VLU while further research is produced.

Variability in compression pressure of multi-layer bandaging applied by lymphedema therapists.

The success in multi-layer bandaging (MLB) relies on the technique of the therapists. The purpose of this study was to elucidate the compression pressure of MLB by lymphedema therapists. We investigated the pressure of MLB applied by 48 lymphedema therapists. The average age was 43.5 (range 23-66) years old. Seventeen (35.4%) of the therapists had the clinical experience of MLB. We prepared ordinary compression materials and asked them to apply MLB to the whole lower limb of healthy volunteers, presuming moderate lymphedema. We attached the probe of Picopress at the Achilles tendon-muscle junction and measured the pressure three times: phase 1, resting condition; phase 2, after ankle exercise; and phase 3, after knee bend. The average pressure in phases 1-3 was 51.9, 48.9, and 45.5mmHg, respectively. Only 13 (27.1%) of the therapists achieved 50-59mmHg which is suitable for lymphedema treatment and the pressure varied by the training courses. The pressure decreased as the blank period got longer after finishing training courses (R = - 0.39). The pressure of MLB varied in different therapists and different training courses. This fact indicated the necessity of uniform curriculum in training courses including measurement of the bandaging pressure.

Comparison of different exercise ankle pressure indices in the diagnosis of peripheral artery disease.

Although the resting ankle-brachial index (ABI) is commonly used as a tool to diagnose peripheral artery disease (PAD), several additional indices measured after exercise may have increased sensitivity for identifying PAD. The aim of this study was to determine the utility of resting ABI and three post-exercise physiological parameters for diagnosing PAD confirmed by arterial imaging studies. For each qualifying study, we assessed the performance measures for identifying PAD for resting ABI < 0.90, exercise ABI < 0.90, a decrease in ABI > 20% with exercise, and a decrease in ankle pressure > 30 mmHg with exercise. Of the 199 exams that met our inclusion criteria, imaging showed a > 75% stenotic lesion in at least one limb in 138 (69%) of patients. For stenoses > 75%, resting ABI < 0.90 had a sensitivity of 64% (95% CI: 56-72%) and exercise ABI < 0.90 had a sensitivity of 88% (95% CI: 82-93%). The sensitivity for a post-exercise ABI decrease > 20% was 67% (95% CI: 59-75%) and the sensitivity for a decrease in ankle pressure > 30 mmHg was 4% (95% CI: 2-9%). For individuals with a normal resting ABI but stenotic lesions > 75% confirmed by imaging (n=49), the addition of exercise ABI testing correctly identified an additional 25% of this population. Overall, exercise ABI < 0.90 exhibits a greater sensitivity for detecting PAD compared to resting ABI. Furthermore, exercise ABI < 0.90 had added clinical utility in patients with normal resting ABIs and was superior to other commonly used exercise indices.

A Study to Compare the Effect of Ankle Exercises on Balance Vs. Ankle Exercises with Visual Feedback on Balance in Stroke Subjects

Objective: The aim of this study was to compare the effectiveness of ankle exercises on balance vs. ankle exercises with visual feedback on balance in stroke subjects. Subjects and Methods: In this study, 30 stroke patients were randomly and equally assigned. They performed ankle exercises for 1 h, five times per week for three weeks. The patients balance ability was measured using Berg Balance Scale (BBS), Timed Up and Go test (TUG) before and after the exercises to compare the effect of ankle exercises. The Stroke Specific Quality of Life (SSQOL) was also used before and after the exercises. Results: In this study the between group mean difference of BBS was 4 ± 3.82, the between group mean difference of TUG was 3.2 ± 0.72 and between group mean difference of SSQOL was 7.8 ± 2.22. The Baseline comparability was analysed using independent t-test and level of significance is p<0.05. This showed that patients in both groups improved significantly following the intervention and the patients treated with ankle exercises with visual feedback on balance had significant improvement in comparison to the patients treated with ankle exercises. Conclusion: Ankle exercises with visual feedback had a positive effect on stroke patients to improve balance.

Development of a New Robotic Ankle Rehabilitation Platform for Hemiplegic Patients after Stroke

A large amount of hemiplegic survivors are suffering from motor impairment. Ankle rehabilitation exercises act an important role in recovering patients' walking ability after stroke. Currently, patients mainly perform ankle exercise to reobtain range of motion (ROM) and strength of the ankle joint under a therapist's assistance by manual operation. However, therapists suffer from high work intensity, and most of the existed rehabilitation devices focus on ankle functional training and ignore the importance of neurological rehabilitation in the early hemiplegic stage. In this paper, a new robotic ankle rehabilitation platform (RARP) is proposed to assist patients in executing ankle exercise. The robotic platform consists of two three-DOF symmetric layer-stacking mechanisms, which can execute ankle internal/external rotation, dorsiflexion/plantarflexion, and inversion/eversion exercise while the rotation center of the distal zone of the robotic platform always coincides with patients' ankle pivot center. Three exercise modes including constant-speed exercise, constant torque-impedance exercise, and awareness exercise are developed to execute ankle training corresponding to different rehabilitation stages. Experiments corresponding to these three ankle exercise modes are performed, the result demonstrated that the RARP is capable of executing ankle rehabilitation, and the novel awareness exercise mode motivates patients to proactively participate in ankle training.

Effect of Ankle Exercise Program and Proprioceptive Training on Stability, Functional Activity Performance in Elderly Population

Effect of Ankle Exercise Program and Proprioceptive Training on Stability, Functional Activity Performance in Elderly Population

Influence of Ankle Exercise on Balance among Community Dwelling Older Adults

Influence of Ankle Exercise on Balance among Community Dwelling Older Adults

Pilot study evaluating the efficacy of exergaming for the prevention of deep venous thrombosis.

Current prophylactic protocols fail to prevent deep venous thrombosis (DVT) in a significant minority of patients, and it remains one of the leading causes of preventable death. We therefore quantified the efficacy of novel game-based exercises (exergaming) to augment femoral venous parameters relative to ankle movement and muscle flexion. Healthy volunteers were recruited to perform a series of ankle and foot exercises using a wireless foot sensor (LEGSys; BioSensics LLC, Watertown, Mass) to navigate a computer cursor sequentially on a screen to the center of 200 circular targets. A single ultrasound technician (W.A.M.) measured each patient's mean flow volume, peak flow velocity, mean flow velocity, and cross-sectional area of the right femoral vein at baseline and obtained immediate postexercise (PEX), 5-minute PEX, and 15-minute PEX measurements. Electromyography (EMG) was performed at baseline and during the exercise. Baseline demographics and medical and surgical comorbidities were also recorded. The primary end point was the difference between baseline and immediate PEX mean flow volume estimates. We secondarily explored the association of baseline characteristics and EMG measurements with femoral vein parameters. Fifteen healthy subjects (53% male; 28.1± 4.6years) completed the exergaming task within a mean of 4minutes, 2± 21seconds. Immediately after exercise, the femoral vein mean flow volume, mean velocity, and peak systolic velocity increased by 49%, 53%, and 48%, respectively (P< .02 for each). Mean flow volume and velocity remained significantly elevated 5minutes after exercise (P< .04 for each). Plantar flexion and dorsiflexion velocities and EMG frequency and intensity were not significantly correlated with PEX mean flow volume estimates (P > .05). Subgroup analysis revealed that women (P< .01) and Hispanics (P< .01) exhibited significantly slower PEX responses. Subjects with the largest improvements in mean flow volume had lower peak plantar flexion velocities (P< .01). Exergaming increases mean flow volume, mean flow velocity, and peak systolic velocity within the femoral vein by approximately 50% above baseline. Exergaming represents a novel and potentially attractive method of DVT prevention by augmenting femoral vein mean volume flow and capitalizing on biofeedback. Less forceful but more uniform contractions were found to be most effective at augmenting venous blood flow. Exergaming will require further validation in larger study bases, among patients at higher risk of DVT.

Can Foot Exercises Alter Foot Posture, Strength, and Walking Foot Pressure Patterns in People with Severe Flat Foot?

Category: Midfoot/Forefoot, Sports Introduction/Purpose: Muscle training muscle control for barefoot running (i.e. doming seated[DS] and standing[DSt]) and post foot and ankle injury (i.e. seated plantar flexion and inversion[SPFI]) are common. Although studies demonstrated improvement in foot posture (validated foot posture index [FPI]) immediately following a 4-week exercise program this was not assessed in people with flatfoot. Also, more rigorous assessment of foot function is lacking (i.e. foot posture, strength, and plantar pressure during walking). There is clearly a need for more rigorous clinical data on the effect of foot exercises. The purpose of this pilot study was to assess the immediate effect of a 4-week exercise program on a comprehensive assessment of foot function to evaluate the potential for a more rigorous clinical trial. Methods: Eighteen individuals, 8 with a severe flatfoot (SFF), measured by FPI (&gt; 6/12, average=8.4±0.7), age=27.8±6.9, 7 females and 1 male) and 9 age/gender matched controls (AMC) with a normal foot (FPI=0-5, average=2.2±2.0) participated. The SFF group completed 3 foot exercises (DS, DSt, SPFI) 5 days/week twice daily. The SFF group were assessed before and after 4 weeks of exercise (called weekly for exercise progression). The control participants were tested once. Testing sessions included plantar pressure during a controlled walking cadence (110 bpm) (average of 5 steps over 40 feet). Masks were applied (medial/lateral toes and forefoot, heal, midfoot) and specific variables calculated (peak pressure, percent mean pressure) during stance phase. Clinical tests included heel rise repetitions, navicular drop, and paper pull test (peak force). T-tests were used to assess the effects of pre to post in the SFF group and between the SFF group and AMC pre and post exercise. Results: Two clinical tests significantly improved from pre to post in the SFF group (heel rises increased on right = 6.1± 3.7, p&lt;0,01, left = 7.9± 6.1, p&lt;0.01, and navicular drop indicated less arch lowering on the right (p=0.4) and left (p=0.06)), however, the paper pull test was not significant. Lateral forefoot mask for percent total mean pressure was lower in the SSF group pre exercise versus AMC (right p=0.02, left p=0.07). However, pre to post exercise the lateral forefoot mask for peak plantar pressure increased (left p=0.014, right p=0.02) and percent of total mean pressure also increased (right p=0.04, left p = 0.07) in the SFF group. Post exercise the SFF group lateral percent total mean pressure was no longer significant compared to controls. Conclusion: This data suggests that 4 weeks of foot only exercises (no ankle exercises) improved walking (Figure 1) and increased ankle strength (heel raise ability). Previous studies have not included rigorous assessment of foot function after foot exercises. This pilot data extends previous studies by suggesting foot muscle control may directly influence foot function during walking (i.e. plantar pressure). A power analysis using this data supports the conclusions with a larger sample of approximately 20-30 people. This pilot data supports the pursuit of a more rigorous trial of the positive effect of foot exercises in patients with severe flatfoot.

Podiatry intervention versus usual care to prevent falls in care homes: pilot randomised controlled trial (the PIRFECT study)

BackgroundCommon foot problems are independent risk factors for falls in older people. There is evidence that podiatry can prevent falls in community-dwelling populations. The feasibility of implementing a podiatry intervention and trial in the care home population is unknown. To inform a potential future definitive trial, we performed a pilot randomised controlled trial to assess: (i) the feasibility of a trial of a podiatry intervention to reduce care home falls, and (ii) the potential direction and magnitude of the effect of the intervention in terms of number of falls in care home residents.MethodsInformed by Medical Research Council guidance on developing and evaluating complex interventions, we conducted a single blind, pilot randomised controlled trial in six care homes in the East of Scotland. Participants were randomised to either: (i) a three month podiatry intervention comprising core podiatry care, foot and ankle exercises, orthoses and footwear provision or (ii) usual care. Falls-related outcomes (number of falls, time to first fall) and feasibility-related outcomes (recruitment, retention, adherence, data collection rates) were collected. Secondary outcomes included: generic health status, balance, mobility, falls efficacy, and ankle joint strength.Results474 care home residents were screened. 43 (9.1%) participants were recruited: 23 to the intervention, 20 to control. Nine (21%) participants were lost to follow-up due to declining health or death. It was feasible to deliver the trial elements in the care home setting. 35% of participants completed the exercise programme. 48% reported using the orthoses ‘all or most of the time’. Completion rates of the outcome measures were between 93% and 100%. No adverse events were reported. At the nine month follow-up period, the intervention group per-person fall rate was 0.77 falls vs. 0.83 falls in the control group.ConclusionsA podiatry intervention to reduce falls can be delivered to care home residents within a pilot randomised controlled trial of the intervention. Although not powered to determine effectiveness, these preliminary data provide justification for a larger trial, incorporating a full process evaluation, to determine whether this intervention can significantly reduce falls in this high-risk population.Trial registrationClinicalTrials.gov identifier: NCT02178527; Date of registration: 17 June 2014.

The Effect of Complex Ankle Exercises on Balance with Functional Ankle Instability in Twenties

The purpose of this study was to investigate the complex ankle exercises on balance. 22 participants (male: 14, female: 8) with functional ankle instability were participated. Functional ankle instability was selected to be less than 24 points using the Cumberland ankle instability tool (CAIT) with people who had severe ankle sprain and then experiencing ankle giving way. A total of 20 minutes performed three times a week for four weeks with muscle strength and balance exercises. Muscle strengthening exercise was performed with Theraband, and balance exercise was performed with unstable support plates. Biodex balance systemⓇ was used to measure static and dynamic balance. The dynamic balance was selected in grade 2, 4, and 8. The static and dynamic balance (grade: 2, 4,and 8) balance was significantly decreased in anterior-posterior, and medial-lateral directions (p<.05). The instability was significantly increased after exercise (p<.05). These results suggest that complex exercises are beneficial to decreasing the functional ankle instability.

The efficacy of forceful ankle and toe exercises to increase venous return: A comprehensive Doppler ultrasound study.

Objective Venous stasis is a risk factor for venous thromboembolism. We aimed to determine the efficacy of forceful foot exercises for actuation of the calf muscle pump to counteract stasis. Methods We examined 20 seated healthy subjects. The peak systolic velocity at the level of the popliteal vein was assessed by Doppler ultrasound. Results The mean peak systolic velocity measurements (in cm/s) were as follows: baseline = 5.6; ankle plantar flexion with toe flexion = 91.0; toe touch heel lift = 107.4; ankle dorsiflexion with toe extension = 193.6; isolated flexion of all toes = 118.8; ankle plantarflexion with 100 and 250 Newton forefoot force = 89.9 and 154.5, respectively. Conclusion All exercises achieved significant increases in peak systolic velocity compared to baseline. Ranking showed that forceful ankle dorsiflexion, plantarflexion with 250 Newtons and forceful flexion of all toes yielded the highest mean peak systolic velocity values (193.6, 154.5, and 118.8 cm/s, respectively).