Ankle Instability Patients Research Articles

Outcomes of the Modified Broström Procedure Augmented With Suture-Tape for Ankle Instability in Patients With Generalized Ligamentous Laxity.

Although recent biomechanical studies have reported mechanical superiority of augmented anterior talofibular ligament reconstruction using suture-tape, clinical evidence regarding the efficacy of suture-tape augmentation is still insufficient. This prospective study was performed to evaluate the outcomes of the modified Broström procedure augmented with suture-tape for chronic ankle instability with generalized ligamentous laxity, which has been known to be a poor prognostic factor for anatomic ligament repair. Twenty-eight patients with generalized ligamentous laxity were followed for more than 2 years after the augmented modified Broström procedures for chronic ankle instability. Generalized ligamentous laxity was defined as a Beighton score ≥4 points. The clinical evaluation consisted of the Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM) score. Measurement of talar tilt angle and anterior talar translation was obtained from stress radiographs to evaluate mechanical ankle stability. FAOS and FAAM scores had significantly improved from preoperative average 63.2 and 54.3 points to 90.6 and 89.5 points at final follow-up, respectively ( P < .001). Talar tilt angle and anterior talar translation had significantly improved from preoperative average 16.2° and 12.1 mm to 3.6° and 4.2 mm at final follow-up, respectively ( P < .001). Preoperative side-to-side comparison with stress radiographs was significantly different, but this returned to within nonstatistical differences at final follow-up, respectively ( P = .105, .532). Although 6 patients sustained an ankle sprain after operation, only 1 patient (3.6%) showed a recurrence of subjective and mechanical instability. Suture-tape augmentation for the modified Broström procedure appears to be an effective operative alternative for chronic ankle instability with generalized ligamentous laxity. As one of the methods to improve the clinical outcomes in patients with relative contraindications of the modified Broström repair, this procedure provided reliable stability with the advantages of anatomic ligament repair through the augmentation using suture-tape. Level IV, prospective case series.

Increased Visual Use in Chronic Ankle Instability: A Meta-analysis.

The underlying cause of balance impairments in chronic ankle instability (CAI) patients remains unknown, but an altered use of sensory information has been hypothesized as a potential cause. The purpose of this systematic review with meta-analysis was to determine whether CAI patients use somatosensory information to the same extent as uninjured controls during static single limb stance. We searched PubMed, CINAHL, SPORTDiscus, and Scopus databases from origin to March 2016 using the combination of key words, including postural control, postural stability, single limb stance, single leg stance, single leg balance, single limb balance, and time to boundary (TTB). Eligible studies had to include instrumented single leg stance with both eyes open and eyes closed in healthy, CAI, or both groups as well as report TTB mean and SD values. A total of 11 articles were identified. Effect sizes using eyes closed to eyes open standardized mean differences and 95% confidence intervals were calculated for all studies that were included in this investigation. Similarly, pooled estimates for each TTB outcome were compared between the CAI and the uninjured control groups. The mean (95% confidence interval) of the mediolateral TTB (control: -1.50 [-1.71 to -1.29]; CAI: -2.04 [-2.31 to -1.77]), anterioposterior mean (control: -2.19 [-2.43 to -1.96]; CAI: -2.82 [-3.13 to -2.52]), and anterioposterior SD (control: -1.81 [-2.03 to -1.58]; CAI: -2.50 [-2.79 to -2.22]) did not overlap, indicating significant differences between two groups. On the basis of our systematic review with meta-analysis, it appears that CAI patients do not use somatosensory information to the same extent as uninjured controls and instead upregulate the use of visual information during single limb stance.

Modified Broström Procedure for Chronic Lateral Ankle Instability in Patients With Generalized Joint Laxity

Background: Generalized joint laxity (GJL) has been considered a risk factor for late failure of ligament reconstruction in the knee; however, it is not known whether GJL is the cause of recurrent instability after the modified Broström procedure for chronic lateral ankle instability. Purpose: To compare the clinical results of the modified Broström procedure for chronic lateral ankle instability in patients with or without GJL. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 100 patients (100 ankles) who underwent the modified Broström procedure were divided into 2 groups, with or without GJL, according to the Beighton criteria. Age and body mass index were matched between the 2 groups. The mean follow-up duration was 43.3 months in the laxity group (44 ankles; Beighton score ≥5) and 42.9 months in the nonlaxity group (56 ankles). Results: The mean preoperative Karlsson and American Orthopaedic Foot and Ankle Society (AOFAS) scores were a respective 53.2 and 60.9 in the laxity group and 53.9 and 62.6 in the nonlaxity group, and these scores improved to 87.4 and 89.5, respectively, in the laxity group and to 94.1 and 94.8, respectively, in the nonlaxity group at final follow-up. The mean preoperative talar tilt angle and anterior talar translation were a respective 12.5° and 8.8 mm in the laxity group and 10.8° and 8.5 mm in the nonlaxity group, and these values improved to 7.3° and 6.0 mm, respectively, in the laxity group and to 5.2° and 5.0 mm, respectively, in the nonlaxity group at final follow-up. Failure rates were 11.4% (5 patients) in the laxity group and 1.8% (1 patient) in the nonlaxity group. Significant differences were found between the 2 groups in terms of the Karlsson score, AOFAS score, talar tilt angle, anterior talar translation, and failure rate at final follow-up (P < .05). Conclusion: Patients with GJL showed inferior outcomes and a higher failure rate compared with patients without GJL. Therefore, GJL appears to be a risk factor associated with recurrent instability after the modified Broström procedure.

In-Vivo Kinematics of the Tibiotalar and Subtalar Joints in Asymptomatic Subjects with Application to Chronic Ankle Instability

Category: Ankle Introduction/Purpose: Measurements of joint angles and translations (i.e. kinematics) are essential to understand the pathomechanics of ankle disease and functional changes following treatment. Traditional motion capture techniques, which track the positions of reflective markers adhered to the skin, cannot measure motion of the tibiotalar and subtalar joints independent of one another. To overcome this limitation, we used high-speed dual fluoroscopy (DF), an x-ray videography technique, to quantify in-vivo kinematics of healthy asymptomatic ankles during activities of daily living. Using these kinematics as baseline data, our secondary objective was to assess preliminary kinematic differences between chronic ankle instability (CAI) patients and asymptomatic control subjects. Methods: High-speed DF images of the hindfoot of ten healthy, asymptomatic adults and four adults with CAI were acquired during treadmill walking at 0.5 m/s and 1.0 m/s and during a single-leg, balanced heel-rise. Three-dimensional (3D) CT models of the calcaneus, tibia, and talus and DF images served as input to the validated model-based markerless tracking software that quantified in vivo kinematics for the tibiotalar and subtalar joints. Dynamic joint kinematics and mean range of motion (ROM) were calculated and reported as dorsi/plantarflexion (D/P), inversion/eversion (In/Ev) and internal/external rotation (IR/ER) angles or translations along the medial/lateral (ML), anterior/posterior (AP), and superior/inferior (SI) directions. Results: During gait, the tibiotalar joint had significantly greater D/P ROM than the subtalar joint (0.5 m/s: p=0.004; 1.0 m/s: p=0.003). The subtalar joint had significantly greater In/Ev (0.5 m/s: p &lt; 0.001; 1.0 m/s: p &lt; 0.001) and IR/ER (0.5 m/s: p=0.01; 1.0 m/s: p=0.02) ROM than the tibiotalar joint. However, during balanced heel-rise, D/P and In/Ev were significantly different between the two joints (p &lt; 0.001; p &lt; 0.001). For AP translation, subtalar ROM was significantly greater than tibiotalar ROM during walking at 0.5m/s (p=0.002). CAI patients often demonstrated rotational profiles with dynamic trends that fell outside the 95% confidence intervals of the asymptomatic subjects (Figure 1). CAI patients exhibited smaller ROM than asymptomatic subjects. However, only 0.5 m/s tibiotalar SI translational (p=0.049) and 1.0 m/s subtalar In/Ev (p=0.03) ROM were significant. Conclusion: To our knowledge, this is the first study to quantify in-vivo joint angles and translations in asymptomatic and CAI subjects. Our results support the belief that the tibiotalar joint is primarily responsible for D/P, while the subtalar joint facilitates In/Ev and IR/ER. Secondary rotational contributions suggest that both joints undergo complex, 3D motion. Our comparison of CAI and asymptomatic subjects is not conclusive, yet suggests that a larger sample size will detect significant differences. With a larger sample size, dual-fluoroscopy may provide insight into the clinical relevance of altered kinematics and the pathomechanics responsible for ankle instability and other pathologies.

The effect of combined mechanism ankle support on postural control of patients with chronic ankle instability.

Chronic ankle instability is associated with neuromechanical changes and poor postural stability. Despite variety of mechanisms of foot and ankle orthoses, almost none apply comprehensive mechanisms to improve postural control in all subgroups of chronic ankle instability patients. The purpose of this study was to investigate the effect of an ankle support implementing combined mechanisms to improve postural control in chronic ankle instability patients. Cross-sectional study. An ankle support with combined mechanism was designed based on most effective action mechanisms of foot and ankle orthoses. The effect of this orthosis on postural control was evaluated in 20 participants with chronic ankle instability and 20 matched healthy participants. The single-limb stance balance test was measured in both groups with and without the new orthosis using a force platform. The results showed that application of combined mechanism ankle support significantly improved all postural sway parameters in chronic ankle instability patients. There were no differences in means of investigated parameters with and without the orthosis in the healthy group. No statistically significant differences were found in postural sway between chronic ankle instability patients and healthy participants after applying the combined mechanism ankle support. The combined mechanism ankle support is effective in improving static postural control of chronic ankle instability patients to close to the postural sway of healthy individual. the orthosis had no adverse effects on balance performance of healthy individuals. Clinical relevance Application of the combined mechanism ankle support for patients with chronic ankle instability is effective in improving static balance. This may be helpful in reduction of recurrence of ankle sprain although further research about dynamic conditions is needed.

Surface electromyography and plantar pressure changes with novel gait training device in participants with chronic ankle instability

BackgroundRehabilitation is ineffective at restoring normal gait in chronic ankle instability patients. Our purpose was to determine if a novel gait-training device could decrease plantar pressure on the lateral column of the foot in chronic ankle instability patients. MethodsTen chronic ankle instability patients completed 30s trials of baseline and gait-training walking at a self-selected pace while in-shoe plantar pressure and surface electromyography were recorded from their anterior tibialis, peroneus longus, medial gastrocnemius, and gluteus medius. The gait-training device applied a medially-directed force to the lower leg via elastic bands during the entire gait cycle. Plantar pressure measures of the entire foot and 9 specific regions of the foot as well as surface electromyography root mean square areas were compared between the baseline and gait-training conditions using paired t-tests with a priori level of significance of p≤0.05. FindingsThe gait-training device decreased pressure time integrals and peak pressures in the lateral midfoot (p=0.003 and p=0.003) and lateral forefoot (p=0.023 and p=0.005), and increased pressure time integrals and peak pressures for the total foot (p=0.030 and p=0.017) and hallux (p=0.005 and p=0.002). The center of pressure was shifted medially during the entire stance phase (p<0.003 for all comparisons) due to increased peroneus longus activity prior to (p=0.002) and following initial contact (p=0.002). InterpretationThe gait-training device decreased pressure on the lateral column of the foot and increased peroneus longus muscle activity. Future research should analyze the efficacy of the gait-training device during gait retraining for chronic ankle instability.

Effect of cognitive task on postural control of the patients with chronic ankle instability during single and double leg standing

The aim of this study was to investigate the effect of a cognitive task on standing postural control of the injured and non-injured leg of athletes with chronic ankle instability. Postural stability was measured by center of pressure parameters while chronic ankle instability patients (n=8) randomly performed single and double leg standing in isolation or concurrently with a digit-backward cognitive task. After performing a concurrent cognitive task, anteroposterior sway significantly decreased in injured leg (P<0.05) and area significantly decreased in both injured and non-injured legs (P<0.05). There was no significant difference in all center of pressure parameters between injured and non-injured legs. The findings confirm the effect of a concurrent digit-backwards memory task on single leg standing balance in chronic ankle instability patients but the response to cognitive loading was not significantly different between the injured and non-injured legs.

Clinical results of an arthroscopic modified Brostrom operation with and without an internal brace.

BackgroundThe concept of utilizing nonabsorbable suture tape fixed directly to bone to augment Brostrom repairs of the anterior talofibular ligament (ATFL) has been proposed. However, no clinical data are currently available regarding the arthroscopic modified Brostrom operation with an internal brace.Materials and methodsThis study involved 85 consecutive patients (22 in the with internal brace group; 63 in the without internal brace group) who could be followed up for >6 months after undergoing an arthroscopic modified Brostrom operation. The American Orthopaedic Foot & Ankle Society (AOFAS) score was administered to assess the functional status. At preoperation and at 24 weeks after surgery, the anterior drawer test was examined clinically.ResultsImprovement of mean AOFAS score in the internal brace group from before surgery to two weeks after surgery was statistically significant (p < 0.05). At 24-week follow-up, the anterior drawer test showed grade 0 laxity in 19 patients (86.4 %) and grade 1 in three patients (13.6 %). Improvement of AOFAS score in the group without an internal brace from before surgery to 6 weeks after surgery was not statistically significant (p = 0.001). At 24-week follow-up, the anterior drawer test showed grade 0 laxity in 54 patients (85.7 %) and grade 1 in nine patients (14.3 %).ConclusionPatients in the internal brace group were able to quickly return to activity and sports. We believe this technique could be a viable option for surgically treating chronic lateral ankle instability in patients who need an early return to activity and sports.Level of evidenceIII.

Effects of ankle destabilization devices and rehabilitation on gait biomechanics in chronic ankle instability patients: A randomized controlled trial

Patients with chronic ankle instability (CAI) have altered gait patterns, which are characterized by increased inversion positioning during gait. Ankle destabilization devices increase peroneus longus muscle activation during gait, which may increase eversion. ObjectiveTo determine whether incorporating destabilization devices into a 4-week impairment-based rehabilitation program has beneficial effects on gait biomechanics and surface electromyography (sEMG) compared to impairment-based rehabilitation without destabilization devices in CAI patients. DesignRandomized controlled trial. SettingLaboratory. ParticipantsTwenty-six CAI patients. Outcome measuresPatients completed baseline gait trials and were randomized into no device or device groups. Groups completed 4-weeks of rehabilitation with or without devices, and then completed post-intervention gait trials. Lower extremity sagittal and frontal plane kinematics and kinetics and sEMG activity were measured. ResultsThe device group increased dorsiflexion during mid-late stance and had lower normalized sEMG amplitude for the peroneus longus during early stance and mid-swing after rehabilitation. The no device group had less peroneus brevis sEMG activity during early stance after rehabilitation. ConclusionIncorporating destabilization devices in a 4-week rehabilitation program was an effective method of improving dorsiflexion during the stance phase of gait. However, impairment-based rehabilitation, regardless of instability tool, was not effective at improving frontal plane motion.

Effect of Wiihabilitation on strength ratio of ankle muscles in adults.

[Purpose] This study was conducted to investigate the effect of Wiihabilitation on the ankle dorsiflexion/plantar flexion strength ratio in adults. [Subjects and Methods] Thirty-two healthy male volunteers were randomly assigned to two equal groups (experimental and control). Participants in the experimental group received a Wiihabilitation training program for six weeks. Data were collected using a Biodex system 3 Isokinetic dynamometer. Peak torques of the dorsiflexors and plantar flexors were measured at an angular velocity of 60°/sec which in turn were used to derive the ankle dorsiflexion/plantar flexion strength ratio. [Results] The mean values of the ankle dorsiflexion/plantar flexion strength ratio decreased significantly between before and after the training in the experimental group, meanwhile there was no significant difference between before and after the training period in the control group . [Conclusion] Wiihabilitation has an impact on the ankle dorsiflexion/plantar flexion strength ratio, so it can be considered an effective training tool in terms of the ankle strength ratio. Thus, it could be recommended for both prevention and rehabilitation of ankle instability patients.

Postural control systems in two different functional movements: a comparison of subjects with and without chronic ankle instability.

[Purpose] The aim of this study was to evaluate postural control during two different movements of the Functional Movement Screen in patients with chronic ankle instability compared with healthy subjects. [Subjects] This study was a cross-sectional survey of 50 participants comprised of 25 chronic ankle instability patients and 25 healthy subjects. [Methods] All subjects were subjected to measurement of the Foot and Ankle Disability Index and center of pressure and Functional Movement Screen testing. The deep squat and hurdle step were performed for the lower extremities in Functional Movement Screen testing. Then, the center of pressure was measured with balance assessment software using a Nintendo Wii Balance Board. The center of pressure path length, velocity, and area of the 95% confidence ellipse and Functional Movement Screen scores were evaluated for all subjects. [Results] The results showed significant differences in center of pressure path length, velocity, and area of the 95% confidence ellipse between the groups for the hurdle step with the non-affected limb. However, there were no significant differences between groups for the deep squat and hurdle step with the affected limb. [Conclusion] The results of this study showed that there was a difference in the hurdle step with the non-affected limb in chronic ankle instability patients compared with normal subjects.

Effects of Virtual Reality Programs on Proprioception and Instability of Functional Ankle Instability

We investigated the effects of a Virtual reality(VR) program on the proprioception and instability of functional ankle instability(FAI) patients. Among the 20s old individuals who lived in Republic of Korea; 20 people were selected through a public participation process. The 20 participants were then randomly divided into two groups, one of strength exercise(n=10) and one of balance exercise(n=10). Of the patients who had experienced an ankle sprain in the past and currently felt ankle instability, those who recorded 24 points or less on the Cumberland ankle instability tool(CAIT) were determined to have FAI. We selected the strength exercise and balance exercise in the Nintendo Wii Fit Plus as a VR program. The subjects used the program on the Wii Balance Board three times per week for 20 minutes and total 10-minute warm-up and down for four weeks. Proprioception and CAIT of the balance exercise group were improved significantly after the exercise compared to before the exercise(p<.05). Authors recommend that the balance exercise in the VR program be used as an aid for physical therapeutic intervention.

Effects of an auditory biofeedback device on plantar pressure in patients with chronic ankle instability

Chronic ankle instability (CAI) patients have been shown to have increased lateral column plantar pressure throughout the stance phase of gait. To date, traditional CAI rehabilitation programs have been unable to alter gait. We developed an auditory biofeedback device that can be worn in shoes that elicits an audible cue when an excessive amount of pressure is applied to a sensor. This study determined whether using this device can decrease lateral plantar pressure in participants with CAI and alter surface electromyography (sEMG) amplitudes (anterior tibialis, peroneus longus, medial gastrocnemius, and gluteus medius). Ten CAI patients completed baseline treadmill walking while in-shoe plantar pressures and sEMG were measured (baseline condition). Next, the device was placed into the shoe and set to a threshold that would elicit an audible cue during each step of the participant's normal gait. Then, participants were instructed to walk in a manner that would not trigger the audible cue, while plantar pressure and sEMG measures were recorded (auditory feedback (AUD FB) condition). Compared to baseline, there was a statistically significant reduction in peak pressure in the lateral midfoot–forefoot and central forefoot during the AUD FB condition. In addition, there were increases in peroneus longus and medial gastrocnemius sEMG amplitudes 200ms post-initial contact during the AUD FB condition. The use of this auditory biofeedback device resulted in decreased plantar pressure in the lateral column of the foot during treadmill walking in CAI patients and may have been caused by the increase in sEMG activation of the peroneus longus.

7 Effects of ankle destabilisation devices in rehabilitation on gait biomechanics in chronic ankle instability patients: a randomised controlled trial

Background Chronic ankle instability (CAI) patients have altered gait patterns characterised by increased ankle inversion motion prior to and following ground contact. Destabilisation devices may improve gait patterns in CAI patients by increasing peroneus longus muscle activity throughout the gait cycle. Objective To determine whether incorporating destabilisation devices (device group) into a 4-week impairment-based rehabilitation program had beneficial effects on gait biomechanics and surface electromyography (sEMG) compared to impairment-based rehabilitation without destabilisation devices in CAI patients. Design Single-blinded randomised controlled trial. Setting Laboratory. Patients Twenty-six CAI patients (age = 21.34 years; sex M = 7, F = 19; height = 168.96 cm, body mass = 70.73 kg) participated. Interventions Patients completed baseline gait trials and were randomised into control or device groups. Both groups completed 4-weeks of rehabilitation with or without devices, then completed post intervention gait trials. Main outcome measurements Ankle, knee, hip sagittal and frontal plane kinematics and kinetics and sEMG activity of the peroneus brevis, peroneus longus, anterior tibialis, and medial gastrocnemius were measured. Data was re-sampled to 100 frames, making each frame represent 1% of the gait cycle where 1% equals initial contact and 100% equals terminal swing. For each measure, group means and 90% confidence intervals (CI) were calculated across all 100 points of the gait cycle. Results The device group increased dorsiflexion motion during mid-late stance (mean difference ± CI;% of cycle: 5.4 ± 2.4o; 45–64%) and had lower normalised sEMG amplitude for the peroneus longus during early stance (2.9 ± 1.4; 4–7%) and mid-swing (1.0 ± 0.5; 73–76%) after rehabilitation. The control group had less peroneus brevis sEMG activity during early stance (3.4 ± 1.3; 4–13%) after rehabilitation. There were no other differences following rehabilitation for either group or when the groups were combined. Conclusion Incorporating destabilisation devices into a 4-week rehabilitation program are effective at increasing dorsiflexion motion during the stance phase of gait. However, impairment-based rehabilitation was not effective at altering frontal plane motion during gait.

Effect Of Neuromuscular Fatigue On Emg Patterns In Subjects With Ankle Instability

Hip abductors and ankle evertors provide dynamic postural stability and muscle fatigue decreases their function, which could lead to lateral ankle sprains. Ankle instability (AI) patients exhibited different neuromuscular control strategies during functional activities compared to healthy subjects. PURPOSE: Examine the effect of fatigue and AI on muscle activity patterns during a forward-side jump. METHODS: 25 AI (23.3±1.9yrs, 176.5±10.5cm, 70.9±11.4kg) and 25 control subjects (23.7±2.5yrs, 175.0±10.8cm, 70.3±12.8kg) performed 5 forward-side jumps before and after fatiguing exercises while EMG signals were collected from the peroneus longus (PL) and gluteus medius (GM). Subjects ran on the treadmill for 5 min at between 5 and 6 mph. Next, subjects performed 20-sec lateral, and 20-vertical jumps. A max vertical jump was measured after each fatigue cycle. Subjects repeated three exercises until RPE reached 17 and the vertical jump fell below 80% of max jump height. Functional linear models (α=0.05) were used to evaluate differences between two conditions (pre- vs post-fatigue) in each group (AI vs control) for PL and GM activation. This analysis compared variables as polynomial functions rather than discrete values. Functions of each condition as well as 95% confidence interval (CI) bands were plotted to determine significant differences. RESULTS: Figure 1. Group by fatigue interactions were found at initial contact in PL and between 30-35% of stance in GM. Fatigue decreased EMG amplitude of PL between 15-50% in the control group and during 0-70% of stance in AI group. Decreased GM activation was found during 30-40% of stance in AI group, but not in control group. CONCLUSIONS: AI group showed greater pre- to post-fatigue reduction in PL and GM EMG amplitude than the control group. Greater deficits of PL and GM activity may infer a greater risk for injury.

Arthroscopic synovectomy in the treatment of functional ankle instability: outcomes and gait analysis

Natural consequence of repetitive ankle sprains is the chronic ankle instability. Objective of this study was to clarify the gait patterns of functional ankle instability (FAI) patients after arthroscopic synovectomy, but also assessment of postoperative recovery. Arthroscopic synovectomy was performed to 14 FAI patients with history of unilateral repetitive ankle sprains, pain, and subjective sensation of instability. At a mean 54 months of follow-up (27-84), clinical assessment was conducted with respect to pain, number of ankle sprains, and American Orthopaedics Foot and Ankle Society (AOFAS) scores. Gait analysis was conducted to determine the temporospatial, kinetic and kinematic parameters at the last follow-up. Mean AOFAS scores increased from 68 (range 55-75) to 89 (range 77-100) points (P < 0.01). Mean ankle sprains was 13 in a period of 23 (range 14-48) months (0.58 per month) and decreased to three sprains in a mean time period of 54 months (0.053 per month) (P < 0.01). Mean preoperative and postoperative VAS scores were 8.0 and 2.9, respectively (P < 0.01). During gait analysis, no significant differences were found in ankle joint, including foot progression angles, ankle dorsi-plantar flexion degrees and ground reaction forces (P > 0.01). Among temporospatial parameters, only double support time showed a significant difference (P < 0.01). All patients were satisfied from the procedure and returned to their previous activity level. Improved long-term clinical results and scores were obtained in our patient group when compared with the preoperative scores. Also, three-dimensional gait analysis showed that the involved ankles demonstrate similar gait patterns to the uninvolved ankles in patients with FAI.

Static balance ability of functional ankle instability patients

Static balance ability of functional ankle instability patients

Assessment of dynamic balance and ankle instability in patients with fibula free flaps using the simple STAR excursion test and its score validation with approved Orthopaedic scores-AOFAS/FADI

Assessment of dynamic balance and ankle instability in patients with fibula free flaps using the simple STAR excursion test and its score validation with approved Orthopaedic scores-AOFAS/FADI

Effect of soft and semirigid ankle orthoses on Star Excursion Balance Test performance in patients with functional ankle instability

To evaluate the effect of soft and semirigid ankle orthoses on dynamic balance assessed using Star Excursion Balance Test in patients with functional ankle instability compared with healthy individuals. Non-experimental, observational study with multiple-factor design, including group (functional ankle instability and healthy) as the between-subjects factor and orthotics condition (no orthosis, soft orthosis and semirigid orthosis) as the within-subjects factor. Sixteen unilateral functional ankle instability patients and a group of 16 healthy control individuals, matched for age, height and weight, participated in the study. Dynamic balance was tested with and without wearing ankle orthosis. Reach distance of participants in 3 bracing conditions were measured in anteromedial, medial and posteromedial directions of Star Excursion Balance Test. Average of 3 trials in 3 measured directions, normalized to leg length of each participant, was used for statistical analysis. There were no differences among orthotics conditions in healthy people. However, normalized reach distance increased from no-orthosis to semirigid to soft orthoses in FAI patients. Differences were significant between soft and no-orthosis (13% in anteromedial, 14% in medial and 15% in posteromedial direction p=0.01) and between semirigid and no-orthosis (10% in anteromedial, 8.5% in medial and 8.5% in posteromedial direction, p=0.01) conditions in all 3 measured directions. The difference between soft and semirigid orthoses was significant (6% difference, p<0.05) only in PM direction. Ankle orthoses improve reach distance in functional ankle instability patients in various reach directions. Soft orthosis has a more pronounced effect on dynamic balance, especially in posteromedial direction, compared with semirigid orthosis.

Validation of the Foot and Ankle Outcome Score in Adult Acquired Flatfoot Deformity

The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score has been under recent scrutiny. The Foot and Ankle Outcome Score (FAOS) is an alternative subjective survey, assessing outcomes in 5 subscales. It is validated for lateral ankle instability and hallux valgus patients. The aim of our study was to validate the FAOS for assessing outcomes in flexible adult acquired flatfoot deformity (AAFD). Patients from the authors' institution diagnosed with flexible AAFD from 2006 to 2011 were eligible for the study. In all, 126 patients who completed the FAOS and the Short-Form 12 (SF-12) on the same visit were included in the construct validity component. Correlation was deemed moderate if the Spearman's correlation coefficient was .4 to .7. Content validity was assessed in 63 patients by a questionnaire that asked patients to rate the relevance of each FAOS question, with a score of 2 or greater considered acceptable. Reliability was measured using intraclass correlation coefficients (ICCs) in 41 patients who completed a second FAOS survey. In 49 patients, preoperative and postoperative FAOS scores were compared to determine responsiveness. All of the FAOS subscales demonstrated moderate correlation with 2 physical health related SF-12 domains. Mental health related domains showed poor correlation. Content validity was high for the Quality of Life (QoL; mean 2.26) and Sports/Recreation subscales (mean 2.12). All subscales exhibited very good test-retest reliability, with ICCs of .7 and above. Symptoms, QoL, pain, and daily activities (ADLs) were responsive to change in postoperative patients (P < .05). This study has validated the FAOS for AAFD with acceptable construct and content validity, reliability, and responsiveness. Given its previous validation for patients with ankle instability and hallux valgus, the additional findings in this study support its use as an alternative to less reliable outcome surveys. Level II, prospective comparative study.